Neurology® Podcast Biopsy-Confirmed Small Vessel Primary CNS Vasculitis
May 29, 2025
Dr. Sumanth Reddy and Dr. Jeffrey Gelfand, both neurologists at UCSF, dive into the intricate world of small vessel primary CNS vasculitis. They discuss the complex clinical features and the vital role of biopsy confirmation for accurate diagnosis. The doctors advocate for early use of cyclophosphamide over glucocorticoids to expedite remission. They also explore the challenges of defining remission and the importance of spinal fluid testing in monitoring disease activity, emphasizing collaborative treatment approaches for better patient outcomes.
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Key Findings on Small Vessel CNS Vasculitis
- Small vessel primary CNS vasculitis shows diverse clinical and radiographic features.
- Early use of cyclophosphamide shortens remission time compared to less aggressive therapies.
Biopsy Essential for Diagnosis
- Biopsy confirmation is critical to confidently diagnose small vessel CNS vasculitis, unlike angiography which misses small vessel details.
- Small and large vessel CNS vasculitis differ in presentation, course, and treatment response.
Clinical Presentation Highlights
- Patients mainly present with headaches and altered mental status, half experience seizures, with parenchymal lesions seen on MRI.
- Stroke and large vessel involvement are rare, differentiating it from larger vessel vasculitis.